Tuesday, December 18, 2012

Asperger syndrome is no more

Asperger syndrome is no more

Asperger syndrome is one of the best known mental health conditions in public consciousness. Teachers, journalists, parents have all heard of it, partly because it is known to be associated with giftedness and with two well-known names.

Gary McKinnon, the Scottish man who hacked into the US military computer when searching to prove a cover up of UFO activity, is the public face of Asperger's.

He was due to be extradited to the US but this was blocked by the British government in October of this year. In the world, of comedy, some may be familiar with the series 'Big Bang Theory'.

It depicts the exploits of four geeks, all neurophysicists. One, Sheldon Cooper is said to have the condition, although not officially "diagnosed". Yet he has an abundance of the features detailed in the scientific literature that include a strangely self-aggrandising style along with difficult understanding irony, sarcasm and humour. He got his first PhD at 16!

In real life other famous people, including Abraham Lincoln, are said to have had Asperger's.

Hans Asperger, an Austrian psychiatrist and paediatrician described a condition which he called autistic psychopathy. He called the children with this condition "Little Professors" because of their intense interest in esoteric topics such as algebra, train timetables, etc, combined with physical awkwardness.

In 1944 the condition was renamed Asperger syndrome in recognition of his work. Other features which he identified were lack of empathy, pedantic speech, problems relating to the social world, accompanied by self-absorption and as a consequence difficulty forming relationships. In their totality there is an impression of eccentricity.

Asperger believed that this condition was related to autism, but unlike autism, intellectual functioning was high. In 1981 a famous child psychiatrist in London, the late Lorna Wing, wrote a paper on the subject describing a case series she had treated. This helped popularise the term and by 1994 it was included in the diagnostic bible of psychiatrists in the US, the Diagnostic and Statistical Manual, 4th edition (DSM-IV).

This tome, published every 10-15 years, details the symptoms required for every recognised psychiatric condition known to the psychiatric profession. The inclusion of a new diagnostic syndrome, such as Asperger's, is of huge significance since it will attract funding for research, just as its removal will have the opposite effect.

The removal of Asperger syndrome from the psychiatric lexicon of disorders is what has just been announced.

When the next edition (DSM 5) is published in 2013 it will not contain Asperger's. Instead it will be replaced by a single term that will also include autism. The new combination will simply be called "autistic spectrum disorder" and it will be measured on a scale from mild to severe.

For many diagnosed with the condition this will be seen as a huge blow since research into this unusual condition will cease. And therein lies one of the problems which has forced its removal – there is little current information even on its prevalence, possible causes or outcome. The distinction from high functioning autism was, apparently, the most pressing reason for its exclusion.

So what is the future for those currently diagnosed with Asperger's? Critics of its elimination are now petitioning that it should continue to be included because studies of educational and social interventions to help those with the condition will now cease. For many, who self- define as "Aspies" the diagnosis has become linked to a range of supportive, non-financial, benefits that they fear will be withdrawn. Families argue that the needs of the children with Asperger's differ from those with autism.

Only time will tell if these fears are realised. What is obvious is that research funding will still continue to be directed to the broad category of autistic spectrum disorder. Asperger's may in the future re-emerge, with a tighter definition and with a strengthened body of knowledge than at present and this can only be good for those currently living with this syndrome.